Basic Information
| Provider Information | |||||||||
| NPI: | 1104933019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN | ||||||||
| FirstName: | ARI | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11011 S 48TH ST | ||||||||
| Address2: | STE 220 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850441779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808932400 | ||||||||
| FaxNumber: | 4808932412 | ||||||||
| Practice Location | |||||||||
| Address1: | 1295 E FLORENCE BLVD STE 1-3 | ||||||||
| Address2: | |||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851224277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204943058 | ||||||||
| FaxNumber: | 5202145059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6838 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 950502 | 05 | AZ | MEDICAID | 113061 | 01 | AZ | MEDICARE TYPE B | OTHER |